Back Pain
Case Scenario: EM is a 74 year old woman admitted into the hospital with a complaint of back pain. She states that she is unable to sit for extended periods of time. During her bouts of pain, her blood pressure
rises substantially. She is a telemetry patient on the floor and is on bed rest. The patient has a
history of Crohn's Disease and in 1997 underwent a sigmoid colon resection. She also has a
history of diverticulitis and COPD. Her final diagnosis consists of back pain related to
degenerative joint disease of the lumbrosacral spine as a result of osteoarthritis.
A. Description of the Disease - Osteoarthritis
Osteoarthritis, also known as degenerative arthritis can cause the breakdown of cartilage between the facet joints. The facet joints are located in the posterior spine. These facet joints consist of two opposing bony surfaces with cartilage in between them. There is a capsule of fluid that allows the joint to move without friction. When these fluids dissipate due to cartilage breakdown, joint movement becomes impaired and eventually, leads to bone against bone friction. Hence, the patient loses motion and as lose mobility, contributing to the onslaught of lower back pain.
B. Symptoms of Osteoarthritis
The primary clinical manifestations of OA are pain, stiffness and functional impairment of the affected joint. The pain in OA is due to an inflamed synovium, stretching of the joint capsule or ligaments, irritation of the nerve endings in the periosteum, tendinitis and muscle spasm. Stiffness is most common in the morning but generally lasts about 30 minutes or so. Functional impairment is based on pain upon movement and guarding, along with the limited m...
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only diagnosed in 2013, she was also diagnosed with epilepsy . As of today her
The patient is a 45 year old male who was in a car accident that
Since one of the prominent concerns she has is related to health, she needs to be reassured by a physician that these symptoms are not dangerous, along with being aware about the fact that she misinterprets these symptoms and these symptoms can be created if she persistently focus on the certain parts of her body.
Musculoskeletal pain affects the bones, muscles, ligaments, tendons and nerves, its commonly but not always it is caused by physical injury, which can be widespread or localised in just one body part. Joint and muscle pain is the probably the number one symptom that prompts people to seek the help of health professionals like osteopaths.
Symptoms of osteoarthritis often develop slowly and worsen over the years. Signs and symptoms include: pain in joints, tenderness, stiffness, loss of flexibility, grating sensation joints (from bone on bone), and bone spurs.
Osteoarthritis is a degenerative joint condition that primarily affects the hands, spine and the ankles and hips. It is known to be associated with aging, and is concerned with the cartilage that protects the joints (the meeting place of two bones). Normal cartilage allows for bones to slide over each other uniformly, acting as a shock absorber to any damage. However cartilage in osteoarthritis, located at the ends of the bones erodes and deteriorates, causing friction and hence pain, swelling and restricted movement. Therefore in osteoarthritic both the composition and appearance of the cartilage alters, while the body attempts to repair this damaged cartilage is broken down faster than it can be built up. A defective repair process can cause bone overgrowth, bone spur/osteocytes to form which can be seen at the ends of the joints. In osteoarthritis the bones come in close contact with each other, and wear away leaving the bone exposed and unprotected.
Osteoarthritis (OA) is the most common form of arthritis, affecting more than 27 million Americans (LeMone, Burke, Bauldoff, 2011). It is caused when the cartilage in the joints breaks down, causing the bones of the joint to rub against one another. This causes pain, stiffness, and loss of motion in the joint. Osteoarthritis is most prevalent in those 65 and older, but can affect those of any age. In addition, African Americans and Hispanics report a higher incidence of arthritis than Caucasians (LeMone, Burke, Bauldoff, 2011). Although the cause is unknown, it is believed that the increasing age of the population, prevalence of obesity and injuries add to the progression of the condition. Osteoarthritis can affect any joint in the body; however, those of the hand, hip, and knee are often the most common. This condition may be asymptomatic, or may present symptoms including soreness, stiffness and pain. The symptoms are more common in the older population, those with limited activity levels, and those who are obese. Joint cartilage thins over time, causing an increased risk for symptoms in the elderly, and obesity puts extra pressure on the joints during activity. Osteoarthritis is commonly diagnosed with the use of a physical assessment along with results of radiology testing such as X-Ray and MRI.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Arthritis affects people of all age groups. More than 100 types of arthritis are known. Among these osteoarthritis and rheumatoid arthritis having the highest incidence. One of the major causes of chronic debilitation in industrialized nations is Osteoarthritis which results from damage to the joints, which may be due to trauma, infection, or age-related wear. Rheumatoid arthritis is encountered less frequently than osteoarthritis and is estimated to affect around one per cent of the world’s population. Amongst patients of Rheumatoid arthritis, women are three times more likely to be affected by this condition than men. This condition is caused by an inflammatory process where the body starts attacking itself. Rheumatoid arthritis also affects several joints, with inflammation sometimes seen in and around the lungs, the heart, the eyes and the skin. The most commonly reported complaint by arthritis patients is pain. The pain might be from the joint itself and be a result of inflammation, damage from the disease, or through daily wear and tear. Muscle pain is also common and is caused by having to force movements against stiff and painful joints. Although range of movement in the affected joint may be limited and uncomfortable, physical exercise has been shown to benefit those with arthritis. Physical therapy has been shown to significantly improve function, decrease pain in the long term and delay the need for surgery in advanced cases. The majority of arthritis cases occur among theelderly, however the disease can occur in children as well. Over 70% of the population that get affected by arthritis in North America are over the age of 65 (4). The disease occurs more commonly in females than males in all races, age groups, and ethn...
There is suggested evidence that a number of anatomical structures such as, bones, intervertebral discs, muscles, ligaments, joints and neural structures cause back pain (Hoy, Brooks, Blyth & Buchbinder, 2010). Degenerative Disc Disease (DDD) is a condition that is believed to cause chronic back pain (Weiner & Nordin, 2010). It occurs when there is an extrusion of disc material into the surrounding tissue (Weiner & Nordin, 2010). It is also suggested that abnormal stress of the ligaments, muscles and mechanoreceptors contribute to back pain (Weiner & Nordin, 2010). The main cause of chronic back pain has not been identified, but there are many suggested issues that are believed to contribute to chronic back pain.
She got a new disease called stenotrophomonas, which is very difficult to treat. She was becoming pan-resistant, meaning she was resistant to everything. She had a bacteria called Gram negative. This bacteria has an armor formed around the negative bacteria that makes it harder for normal antibiotics to cure it. She was left with only one option, a lung transplant. For one, it was a very risky option since her body was so weak, and two, she would have to wait until a transplant even came up for her to have. She ended up getting the lung transplant though. Two years after she came home from the operation and she is still alive, but she has to be very cautious every day. She takes a handful of prescriptions twice a day and still picks up bacteria easily. Her mom said she has gotten pneumonia twice already. Her life is now extremely difficult, but she is at least
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
D. standing near her room, breathing sharply. While asked what has just happened, she answered, ‘I feel dizzy and can faint!’ Mrs. D. then explained that she rose up from her chair in the television room and felt lightheaded. I decided to bring her to the room hoping she would feel less dizziness if she could sit. After consultation with my mentor and third year unit nursing student, I decided to perform measurement of her vital signs. Since only electronic sphygmomanometer was available for me that time, I had to use it for my procedure. Gladly, I discovered that I have already used such equipment in my previous nursing practice. Using the standard sized calf, I found that her blood pressure was 135/85, respirations were 16, and her pulse was 96 beats per minute (bpm). However, I decided to recheck the pulse manually, founding that it was irregular (78 bpm). The patient stated that she felt better after rest. Immediately after the incident I made a decision to explore carefully the medical chart of Mrs. D., along with her nursing care plan. That helped me to discover multiple medical diagnoses influencing her